在中國建立基于高級醫(yī)療救護員的院前急救體系：來自國際搜索與救援咨詢團醫(yī)療工作組前任主席的建議

Trevor Glass

鄧朝陽 翻譯，郭 曉，郭海濤 審校

? 讀者來信| LETTERS TO THE EDITOR ?

在中國建立基于高級醫(yī)療救護員的院前急救體系：來自國際搜索與救援咨詢團醫(yī)療工作組前任主席的建議

Trevor Glass1,2

鄧朝陽 翻譯，郭 曉，郭海濤 審校

A paramedic by definition is someone specially trained to provide emergency medical care in cases of injury or illness before and during transportation to a hospital. China currently does not have a paramedic based ambulance service. In China, doctors and nurses work on the ambulances. Countries like Australia, Canada, New Zealand, South Africa, UK and the USA, to name a few examples, have well-established paramedic based ambulance services.

根據(jù)定義，高級醫(yī)療救護員是經(jīng)過專門訓(xùn)練，為傷病員提供院前或轉(zhuǎn)運途中緊急醫(yī)療護理的人員。中國目前還未建成由高級醫(yī)療救護員提供院前急救服務(wù)的體系。在中國，醫(yī)師和護士們在救護車上工作。舉幾個例子來說，國家諸如澳大利亞、加拿大、新西蘭、南非、英國和美國，已經(jīng)建立了完善的由高級醫(yī)療救護員提供院前急救服務(wù)的體系。

The current staffing model in China, namely doctors and nurses, relies on expensive human resources that take a long time to train in their respective disciplines. The doctors and nurses working on ambulances are then assigned to work in an environment that they have not been specifically trained to work in. There is a severe shortage of nurses in China, and the rest of the world for that matter, and having nurses working on ambulances places even further human resources demands on the hospitals that are already struggling to fulfill their own nursing requirements. The situation is very similar with doctors. Both the doctors and nurses assigned to ambulances could in fact be more effectively utilized inhospitals. Neither the doctors nor the nurses have been specifically educated to work on ambulances. However, until there is a suitable and appropriate alternative, the situation of doctors and nurses working on ambulances in China will continue. A paramedic is the ideal alternative as it places someone with a specific interest in out-of-hospital (also referred to as pre-hospital) emergency medical care, and who has been specifically educated and trained in prehospital emergency medical care, on ambulances. It will obviously take several years before paramedics could take over the role of the doctors and nurses currently working on ambulances, however, the sooner one starts the paramedic system, the sooner there will be Chinese paramedics that can enter the system and the sooner the doctors and nurses will be able to be utilized in the environment for which they have been specifically trained, i.e. hospitals, which will reduce the pressure of staffing shortages.

中國目前的人員配置模式，即醫(yī)師和護士模式，依賴昂貴的人力資源，他們需要在各自的學(xué)科內(nèi)培訓(xùn)很長時間。救護車上工作的醫(yī)師和護士被分配到一個未經(jīng)過專業(yè)訓(xùn)練的環(huán)境中工作。在中國，護士嚴(yán)重短缺，世界上其他國家也是如此，讓護士在救護車上工作，導(dǎo)致醫(yī)院的人力資源短缺問題進一步加重，而醫(yī)院本身的護士需求早已是捉襟見肘。這種情況與醫(yī)師的問題非常相似。事實上被分配到救護車上的醫(yī)師和護士可以在醫(yī)院得到更有效利用。醫(yī)師和護士都未曾接受專業(yè)的救護車訓(xùn)練。無奈的是，中國醫(yī)師和護士在救護車上工作的狀況將持續(xù)下去，直到出現(xiàn)一個適當(dāng)?shù)奶娲桨?。高級醫(yī)療救護員是理想的選擇，因為它將一些對院外（也稱院前）緊急醫(yī)療救護服務(wù)有特殊興趣的，并且經(jīng)過專業(yè)的教育及已在院前緊急醫(yī)療救護服務(wù)中訓(xùn)練過的人員配置在救護車上。顯然，由高級醫(yī)療救護員替代目前救護車上工作的醫(yī)師和護士的角色還需要幾年時間。然而，高級醫(yī)療救護員急救體系開始得越早，中國自己培養(yǎng)的高級醫(yī)療救護員進入體系的時間就會越早，醫(yī)師和護士將會被越早配置在他們接受過專業(yè)訓(xùn)練的環(huán)境中，比如說醫(yī)院，這將減少人員短缺的壓力。

In countries with paramedic systems, when paramedic training was first introduced, it was conducted by attending a series of short courses, some are a few weeks long, others a few months . Each course led to a higher level of certification until the highest paramedic qualification was obtained. However, the education of paramedics has evolved significantly over the years. In many countries with highly developed paramedic systems, paramedic education is now university based. Student paramedics attend a Bachelor Degree run over 3 or 4 years (depending on the country) and then have the option to further their studies with a Master’s and ultimately a PhD.

在具有高級醫(yī)療救護員體系的國家，當(dāng)高級醫(yī)療救護員培訓(xùn)被首次引入時，它是通過參加一系列的短期課程得以實施的，課程有些幾周長，有些幾個月長。每門課程完成后學(xué)員將被頒發(fā)一個更高水平的證書，直到取得最高級別的高級醫(yī)療救護員資格。并且，高級醫(yī)療救護員的教育在近幾年有了顯著進步。在許多擁有高度發(fā)達高級醫(yī)療救護員體系的國家，其教育目前是依托大學(xué)進行的。高級醫(yī)療救護學(xué)員需要參加一個為期3或4年的學(xué)士學(xué)位學(xué)習(xí)（根據(jù)不同的國家而定），然后可以選擇繼續(xù)攻讀碩士乃至博士學(xué)位。

There are several advantages to develop a paramedic based ambulance system in China, including:

· It creates a completely new academic pathway for people wanting to obtain a university degree;

· In time it will create a new academic pathway for Masters and PhD studies;

· It creates a completely new revenue stream for universities;

·It creates a completely new employment opportunity for thousands of Chinese citizens as paramedics;

·In time it will professionalize the ambulance service in China as you will have dedicated professionals employed in the service;

·In time it will reduce the human resource burden on doctors and nurses in hospitals;

·Military personnel could also be educated as paramedics and can then be utilized by the military medical units ;

·It places China the forefront of advances and developments in the education of paramedics worldwide;

·In time, it would place China in alignment with leading paramedic systems worldwide.

中國發(fā)展基于高級醫(yī)療救護員的院前急救體系具備一些優(yōu)勢，包括：

·對于想要獲得大學(xué)學(xué)位的人來說，它創(chuàng)建了一個全新的學(xué)術(shù)路徑；

·它最終將創(chuàng)建一個新的碩士和博士學(xué)術(shù)研究路徑；

·它將為大學(xué)創(chuàng)造一個全新的收入來源；

·它將為成千上萬的中國公民創(chuàng)造一個新的就業(yè)機會，使其成為高級醫(yī)療救護員；

·同時，它將使中國的院前急救服務(wù)專業(yè)化，因為你將能雇傭到專職的救護服務(wù)人員提供服務(wù)；

·它將最終減輕醫(yī)院里醫(yī)師和護士短缺所造成的人力資源負(fù)擔(dān)；

·軍隊人員也可以接受高級醫(yī)療救護員教育，并且被軍隊的醫(yī)療分隊使用；

·它使中國成為世界范圍內(nèi)高級醫(yī)療救護員教育之進步和發(fā)展的前沿；

·它將最終讓中國融入世界先進的高級醫(yī)療救護員體系。

Obviously, paramedic education forms only one piece of a larger puzzle, as is illustrated in Figure 1. There would be no point in starting a new paramedic education pathway at universities if there were no employment opportunities for graduates. Prospective graduates would need to be enticed with the prospect of a new and exciting career option. A national register would need to be established for paramedic graduates, similar to what happens currently with doctors and nurses. Then there is also the requirement to have a registration/regulation body that would stipulate the clinical scope of practice for paramedics and ensure paramedics keep up to date with new developments in emergency care and maintain their clinical skills to the required levels.

顯然，高級醫(yī)療救護員教育只是急救醫(yī)療體系大難題的一部分，如圖1所示。如果畢業(yè)生沒有就業(yè)機會，大學(xué)就沒有開設(shè)新的高級醫(yī)療救護員教育的立足點。準(zhǔn)畢業(yè)生需要被一個新的和令人興奮的職業(yè)選擇所吸引。就像現(xiàn)在的醫(yī)師和護士一樣，高級醫(yī)療救護畢業(yè)生也需要國家建立的注冊制度。而后還需要成立一個注冊/管理機構(gòu)，用來規(guī)定高級醫(yī)療救護員的臨床實踐范圍，確保他們獲取最新的緊急醫(yī)療救護服務(wù)知識，同時保持其臨床技能符合相應(yīng)水平的要求。

Therefore, there is a need to make a collective agreement among the relevant stakeholders (universities, department of health, employers) that the establishment of a paramedic based ambulance system in China is worth exploring. Once there is a collective, inprinciple agreement, work could commence, in parallel with thevarious stakeholders, on establishing the various components of a China Paramedic System Framework.

因此，利益相關(guān)者（大學(xué)、衛(wèi)生部門、雇主）需要簽署一個集體協(xié)議，成立基于高級醫(yī)療救護員的院前急救體系，這在中國是值得嘗試的。一旦原則上的集體協(xié)議達成，建立高級醫(yī)療救護員體系的工作即可以啟動，各利益相關(guān)者同步開始運作，創(chuàng)建中國高級醫(yī)療救護員系統(tǒng)框架所需的各種機構(gòu)。

圖1 高級醫(yī)療救護員急救體系的基石

There will be a minimum of a 3 year time-frame (maybe four years depending on the duration of the degree) in which this framework was established as the first group of graduates would only qualify and be ready to enter into the work place after graduation. It would also be advisable to run a limited pilot program initially, and once the lessons from that program had been identified and addressed, then the role out on a larger scale could begin.

建立這個框架的時限將最少是3年（可能需要4年，這取決于學(xué)位教育的時間長短），因為此時第一批畢業(yè)生已經(jīng)取得資格并且準(zhǔn)備在畢業(yè)后進入工作場所。我們建議最初開展一個有限的試點項目，一旦獲得第一個試點項目的經(jīng)驗教訓(xùn)被識別和解決，那么大范圍的推廣工作就可以啟動了。

I know that this would be an extremely large undertaking, as it requires the establishment of a completely new national system. However, China has a great vision of its future many decades ahead. Therefore, I am optimistic and confident that it can be achieved and successfully implemented over time.

我知道，這將是一個非常宏大的事業(yè)，因為它需要建立一個全新的國家體系。然而，中國對其幾十年后的未來有一個偉大的愿景。因此，隨著時間的流逝，這可以實現(xiàn)并成功實施，我對此是樂觀和有信心的。

I am a paramedic by profession and this is a topic I am most enthusiastic and passionate about. Although it is a project that would have to run over many years, once implemented, it would greatly benefit the people of China. Similar to the Great Wall of China, those that initially had the idea and began the construction never lived to see the wall completed, but many, many generations benefited from their efforts. Due to the enormity of the project, it would need support very much from the highest governmental level.

我的職業(yè)是一名高級醫(yī)療救護員，這個領(lǐng)域讓我充滿了熱情和激情。盡管這是一個需要運行多年的項目，但是一旦實施，它將會使全中國人民受益。如同中國的萬里長城一樣，那些最初有想法并開始建造的人們最終沒有活到親眼看到長城建成的那一天，但后輩們因為他們的努力而受益。由于這項工程的龐大，尤其需要得到政府最高級別部門的支持。

（2015-11-08 收稿 2016-01-04 修回）（責(zé)任編輯 郭 曉）

Trevor的院前急診醫(yī)學(xué)職業(yè)生涯開始于1988年作為一名軍事作戰(zhàn)的醫(yī)護兵。當(dāng)他服完兵役時已具備實施高級生命支持的paramedic資格。作為一名工作在直升機上的paramedic，Trevor具有醫(yī)療救援和直升機轉(zhuǎn)運服務(wù)雙重平臺的多年工作經(jīng)驗。自2000年來，Trevor參與了醫(yī)療特別行動，被部署到阿爾及利亞，伊朗，巴基斯坦，印度尼西亞和新西蘭地震現(xiàn)場實施醫(yī)學(xué)救援。在2004年12月他辭去了南非最大的私人急救服務(wù)公司的首席執(zhí)行官職務(wù)，開始作為一名國際顧問為聯(lián)合國（UN）國際搜索與救援資訊團（INSARAG）工作，并在2008年初至2014年2月?lián)蜪NSARAG醫(yī)療工作組（Medical Working Group, MWG）的主席。Trevor起草或參與起草了一些MWG文件，并被邀請在美國醫(yī)學(xué)特種行動會議上發(fā)言。目前，他擁有并管理著一家總部設(shè)在英國的公司——DART Solutions，專門提供災(zāi)難和應(yīng)急管理的咨詢、培訓(xùn)和響應(yīng)服務(wù)。Trevor是一名充滿熱情的活躍的臨床paramedic。

Establishment of paramedic based ambulance system in China: Proposal from Former Chairman of the INSARAG Medical Working Group

Trevor GLASS1，2. 1. Chairman of the INSARAG Medical Working Group from 2008-2014; 2. Managing Director, DART Solutions (a UK-based company that provides consultancy and training services for disaster and emergency management).

10.13919/j.issn.2095-6274.2016.01.017

Trevor Glass，本科學(xué)歷，E-mail: trevorglass00@gmail.com

1. 國際搜索與救援咨詢團醫(yī)療工作組2008—2014主席；2. 常務(wù)董事，DART Solution 公司，一家總部設(shè)在英國的，提供災(zāi)難和應(yīng)急管理咨詢和培訓(xùn)服務(wù)的公司